Hospital Implements High-Tech Emergency Response SystemHospital Implements High-Tech Emergency Response System

GPS-enabled cell phones and other mobile location-tracking technologies used for Enhanced 911 capabilities are helping emergency response workers find people in trouble.

The deployment of a geographic information system and mobile applications in southern California is enabling emergency response personnel to more quickly and efficiently deploy rescue teams based on near real-time data about traffic conditions, the location of nearby ambulances and helicopters, and other factors, such as bed availability at area hospitals.

And soon, field personnel will be able to use mobile devices, including cell phones and laptop computers, to securely send rescue teams additional information -- such as on-the-fly map drawings showing where a triage area has been set up in a crisis -- so that other mobile emergency workers know exactly where to go.

The Advanced Emergency Geographical Information Systems (AEGIS) at Loma Linda University Medical Center in Loma Linda, Calif. is a Web-based hospital situational awareness system that monitors and maps the location and status of emergency resources, including area hospitals, ambulances, and rescue helicopters.

Currently, Loma Linda University Medical Center's AEGIS system is being used for emergency medical response in a vast geographic region of Southern California covering 25% of the state. The next phases of the system's development will provide functionality for all public safety organizations -- including police and fire departments, and even the U.S. military -- in multiple counties to manage all sorts of disasters.

The rollout by Loma Linda University Medical Center has been several years in the making with the help of funding from a U.S. Department of Defense telemedicine grant and technology from GIS vendor ESRI. The AEGIS deployment is also serving as a model disaster-response management system not only for other communities in the United States, but also for the U.S. military, said Dr. Steve Corbett, chief medical informatics officer of Loma Linda University Adventists Health Sciences Center.

Loma Linda University Medical Center includes a trauma center and pediatric hospital that handles about 3,000 ambulance runs in the region each month, said Corbett. Currently, LLUMC is the only level-one trauma center serving several counties in southern California, including Inyo, Mono, Riverside, and San Bernardino County, where LLUMC is located.

Loma Linda University Medical Center uses AEGIS for emergency response dispatch, transport, and destination decisions. For instance, if a freeway accident involves multiple victims, emergency managers can view real-time data on a Web-based map to see which ambulances or helicopters are in the area, and click onto icons of area hospitals to see if they're accepting casualties or if they're currently overloaded with patients.

The system collects data from a variety of sources, including the state highway patrol, highway video cameras, and road sensors that can update emergency managers about how fast traffic is moving on a road, all information that can help responders make better decisions about where and how to route victims, said Corbett.

"We created this as a medical emergency management system, but it's turning into a disaster management system that's interactive and also being rolled out for use by EMS, police, fire, public health officials," said Corbett. "The true potential is disaster management for all public safety," he said. "It's built to fit anywhere," he said.

New functionality will allow secure role-based interaction by authorized mobile users in the field. "Someone at the scene could draw [on the system's map] a staging area for ambulances -- here's the disaster area where we have more victims for triage," he said. In addition, response workers "from miles away could also interact by sending text messages via the map" to provide context of the local situation, he said. Loma Linda University Medical Center has the second-largest bay station in the county, said Corbett. The use of the system is being expanded in to neighboring counties, including Los Angeles County and Santa Clara County. San Bernardino is "enormous but sparsely populated, GIS helps us determine what's the nearest facility based on a patient's needs," say Corbett.

In the next phase of development, scheduled to roll out in August, the additional AEGIS functionality will enable the system's use by all regional public safety organizations for disaster management, said Ed Carubis, principal consultant and senior program manager of ESRI professional services.

"The real-time situational awareness applications [of AEGIS] accomplish their mission through multiple location services," said Carubis, who, before joining ESRI, was a CIO for the New York City Department of Health and was involved in the post-9/11 development of a bio-surveillance system to collaborate with hospitals, emergency workers, and the Centers for Disease Control to monitor the outbreak of disease.

"It doesn’t take much for a large casualty event to bring hospitals to capacity, hospitals don't have a lot of extra beds," Carubis said. "There needs to be a regional approach for response of care in wider areas to make those decisions," he said. "As horrific as 9/11 was, it had a small footprint" compared to the sort of havoc that occurs in other disasters, like Hurricane Katrina, which covered a multistate region, he said.

AEGIS uses location-based technologies, including automatic vehicle location, which is a set of capabilities consisting of GPS mounted on vehicles like ambulances, fire trucks, police cars, and helicopters, said Anak Agung, ESRI senior consultant. The vehicles transmit their data through "wired or wireless, cell phone network, direct satellite communication, Wi-Fi, and a Web service that processes the location data transmitted by vehicles, and serves the locational data to other users," including ArcGIS Mobile users, he said.

ArcGIS Mobile, a part of ESRI's ArcGIS server, is the GIS technology that enables mobile users working on laptop, tablet PC, PDA, and mobile phone to be connected with enterprise GIS, said Agung. "It allows users to synchronize data they input from the fields and share data from other users at nearly real time," he said. It also allows mobile users "to run sophisticated analysis provided by a server using the field data input," he said.

"For example, based on the current location of a mobile user, one can ask the server to analyze drive time and to report back from the server the multi-rings polygon indicating drive times, and find out other mobile users within each polygon," he said.

This information helps emergency response managers and public safety officials make better informed decisions, such as choosing the routes and destinations for helping critically injured patients and other victims of an emergency or disaster. Input from users in the field will also allow emergency responders, for instance, to alert other responders en-route in a disaster that there are fallen trees or debris blocking a road leading to a crisis area.

When not being used to manage real emergencies, AEGIS can also provide simulation training, not only for new users, but also as a cost-effective means for hospitals and regions to participate in disaster preparedness, Carubis said.

The system is also built to help emergency response and public safety officials handle more routine situations. "You don't want a system only for mass casualties, you want to use it on a day-to-day basis," which also helps prepares responders when a large crisis does occur. "You want this to be second nature," Carubis said.